Only 7% of ischemic stroke events in the US receive thrombolysis (t-PA) therapy due to delayed hospital arrival, most often related to the failure to recognize stroke symptoms and to call 911 immediately. If the current 7% rate of all ischemic stroke patients receiving tissue plasminogen activator (t-PA) is increased to only 10%, the realized annual cost savings to taxpayers would be more than $45m. Moreover, it has been estimated that interventions designed to educate patients to seek immediate treatment when a stroke occurs may increase thrombolysis rates to 57%, if emergency medical system response times and in-hospital response times are optimized. The goals of this project are to disseminate a novel, evidence-based stroke preparedness (ability to recognize stroke symptoms and call 911 immediately) behavioral intervention to increase ambulance use for stroke, and to identify contextual influences, including barriers and facilitators that affect adoption, implementation, fidelity and maintenance. The program is being disseminated under the auspices of the New York State (NYS) Department of Health Stroke Center designation program to 47 NYS designated stroke centers for implementation in their local catchment area schools. We will use a Hybrid Effectiveness-Implementation Type 3 design that will be informed by the Consolidated Framework for Implementation Research (CFIR). Stroke Centers will serve as hubs for disseminating and implementing our intervention in their local schools. Our intervention, which we have named Hip Hop Stroke, is a novel school- based, multimedia program targeting 4th through 5th graders that uses a framework of Child-Mediated Health Communication to make children stroke literate and then empower these stroke literate students with the tools required to successfully communicate actionable stroke knowledge (recognition of stroke symptoms and the urgency of calling 911) to their parents and grandparents at home. The effectiveness of Hip Hop Stroke has been established in a recently completed NIH funded study, and our intervention has been cited in major stroke prevention guideline articles. Hip Hop Stroke is well known within the NYS stroke community, has shown high acceptability among NYS schools and, most importantly, helps Stroke Centers fulfill their annual regulatory community stroke education mandates.